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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603293
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:08:09 AM

Document Has Been Signed on 06/13/2022 11:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INC.FACILITY NUMBER:
197603293
ADMINISTRATOR:RUNTU, RAMAMITAFACILITY TYPE:
775
ADDRESS:320 WEST COLORADO BLVD.TELEPHONE:
(818) 550-8400
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 45CENSUS: 2DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Director She-ri Glendenning TIME COMPLETED:
11:13 AM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Program Director She-ri Glendenning and explained the purpose of the visit. Facility is an Adult Day Care program. During the visit, LPA observed the following: reception/visitor area, program directors office, vocational area, library/quiet area, leisure area, fitness area, cafe area, kitchen(refrigerator, microwave, storage cabinets), lead staff area, relaxation area (used if clients need some quiet time or are not feeling well), locked storage rooms(toxins), music area, arts and crafts area, 2 restrooms, 1 changing room, and a locker room area. The cafe, kitchen, and restrooms were clean and operable. Hot water was tested, and the temperature measured 111.1 - 113.7 degrees F
The last fire drill was completed on January 2020.

The following were observed/inspected:
• COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept.
• Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing.
• Facility has no designated isolation room as clients would not be allowed if Covid positive.
• Seven (7) activity rooms, common areas, bathrooms, and outdoor physical plant was inspected.
• Zero (0) centrally stored client medication records were reviewed as program is currently remote.
• Staff responsible for direct care and supervision were observed wearing masks.
• Clients were not present at time of visit as facility.
• Only snacks are provided at program and emergency food supply was observed.
• A posted Emergency Disaster Plan was not observed.
• PPE's were observed.
• Staff and resident files were not reviewed during today's visit.
• Deficiencies cited (see 809D for details)

Exit interview was conducted with Director She-ri Glendenning. A copy of the report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/13/2022 11:08 AM - It Cannot Be Edited


Created By: Alberto Lopez On 06/13/2022 at 10:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 197603293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
(a) the program shall be clean, sanitary and in good reair at all times for the safety and well beeing of the clients, staff and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation LPA and Director observed the facet in Kitchen sink in disrepair and the light swittch in woman's restroom is broken which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2022
Plan of Correction
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Liecencee will reapair or replace facet inkitchen and repair lightswitch in woman's bathroom by POC and send proof to LPA in form of photo, receipts and/or self certification.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stefanie Coronel
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2022


LIC809 (FAS) - (06/04)
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